Usefulness of Implantable Cardioverter-Defibrillators in Patients with Coronary Spasm and Inducible Ventricular Arrhythmia

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Background: Coronary artery spasm is one of causes of life-threatening ventricular arrhythmia and sudden cardiac death, but indication of implantable cardioverter-defibrillators (ICDs) is controversial. Our aim is to reveal the clinical features and long term prognosis of vasospastic angina patients with ventricular arrhythmia. Methods: We investigated retrospectively 31 survivors of cardiac arrest with implantation of ICDs. All patients underwent coronary angiography, and without ischemic findings we performed acetylcholine provocation test and electrophysiological study. Results: In 5 patients (56.6±15.7 years old, 5 males) multi-vessel spasm was induced by acetylcholine injection, and in 4 patients of them ventricular fibrillation were inducted by right ventricular 3 extrastimuli, and in 1 patient ventricular tachycardia was inducted by right ventricular 2 extrastimuli. All patients were treated with calcium channel blocking agents, isosorbide and antiarrhythmic drug. During mean follow up of 37±16.9 months (between 25 to 66 months), 2 patients received appropriate ICD shocks to ventricular fibrillation respectively in 10 and 14 months after implantation. One patient had a saddle-back-type ECG abnormality, and in another patient ventricular tachycardia was easily induced by right ventricular 2 extrastimuli. Conclusion: In patients with coronary spasm and inducible ventricular arrhythmia ICDs is useful to prevent sudden cardiac death.